Juliano Roberto Vaz, Mendonça Rafaela R, Meyer Fernando, Rubinstein Maurício, Lasmar Marco Túlio Coelho, Korkes Fernando, Tavares Alessandro, Pompeo Antonio Carlos Lima, Tobias-Machado Marcos
Division of Urology, ABC Medical School, Santo André, Sao Paulo, Brazil.
J Laparoendosc Adv Surg Tech A. 2011 Jun;21(5):399-403. doi: 10.1089/lap.2010.0281. Epub 2011 May 11.
The aim of the present study was to analyze long-term follow up (18-108 months) of different techniques and routes for laparoscopic repair of uretero-pelvic junction obstruction comparing efficacy and results.
A retrospective analyses of 133 laparoscopic pyeloplasties in 132 patients (mean age 35 years) between August 1995 and November 2008 was performed. Transperitoneal route was performed in 114 patients, and retroperitoneal route was performed in 19 patients. Different repair techniques (dismembered and non-dismembered) were applied at the surgeon's discretion.
Average operative time was 127 minutes (range 45-370). Average blood loss was 127 mL, and mean hospital stay was 24 hours. Complications occurred in 9.6% of surgeries, and conversion rate was 1.7%. Urinary leak occurred after eight (6.1%) surgeries, all managed conservatively. Overall success rate of laparoscopic repair was 96%, higher for dismembered versus non-dismembered procedures (97% versus 89%, P = .04).
Laparoscopic pyeloplasty is a reproducible, highly effective, and minimally invasive treatment for uretero-pelvic junction obstruction. Surgical technique affects operative time and long-term success rates. Dismembered techniques seem to remain more effective after a long-term follow up. Surgical route does not seem to affect success rates.
本研究旨在分析腹腔镜修复肾盂输尿管连接部梗阻的不同技术和途径的长期随访情况（18 - 108个月），比较其疗效和结果。
对1995年8月至2008年11月期间132例患者（平均年龄35岁）的133例腹腔镜肾盂成形术进行回顾性分析。114例患者采用经腹途径，19例患者采用经后腹膜途径。不同的修复技术（离断性和非离断性）由外科医生酌情应用。
平均手术时间为127分钟（范围45 - 370分钟）。平均失血量为127毫升，平均住院时间为24小时。9.6%的手术发生并发症，中转开腹率为1.7%。8例（6.1%）手术后发生尿漏，均经保守治疗处理。腹腔镜修复的总体成功率为96%，离断性手术的成功率高于非离断性手术（97%对89%，P = 0.04）。
腹腔镜肾盂成形术是治疗肾盂输尿管连接部梗阻的一种可重复、高效且微创的治疗方法。手术技术影响手术时间和长期成功率。长期随访后，离断性技术似乎仍然更有效。手术途径似乎不影响成功率。
